Radiology departments perform imaging procedures every day. Each of these procedures requires a set of precise specifications of their use. Such precise specifications of use are a protocol. In some cases, especially in larger institutions, the radiologists take the time to formalize their way of working in documents describing their protocols. The edition of such a document is usually done by a group of expert radiologists, after peer-review, using standard, non-dedicated office applications such as a text processing program. The purpose of having written protocols is to ensure consistency, such as for example, by making sure that patients with similar indications are examined the same way and to minimize errors in patient handling and protocol choice and adaptation. Protocols are also useful to train new radiologists and technologists.
Protocols contain different pieces of information that completely define the imaging procedures and serve as guidelines for imaging practices. Examples of such information include a unique name, a modality used (e.g., Computed Tomography (CT), Magnetic Resonance (MR), Nuclear Medicine (NM), X-rays (XR), Ultrasound (US), etc.), body area scanned (e.g., head, chest, etc.), list of clinical indications justifying the use of this specific protocol, list of types of imaging sequences and associated set of parameters, additional comments (e.g., describing the fact that this imaging procedure is a fast acquisition procedure to be used for uncooperative adults or non-sedated children), and patient handling (e.g., preparation, positioning in the scanner, administration of contrast agent, etc.).
Protocols are usually developed for an individual institution having unique practices and local settings: types of modality, types of scanner and types of procedure performed i.e. a trauma center does not perform the same procedures as a cancer center. In particular, for larger institutions (e.g. network of hospitals covering a large population area), multiple radiology departments exist and over the years, develop their own protocols, even if they interact frequently. As practice evolves over time, regular updates of these protocols are necessary to maintain efficiency, diagnostic accuracy and quality of care. The protocols should be consistent throughout a given medical institution.
Such updates are usually done through a committee of expert-radiologists and possibly consultation with specialty doctors with an attempt to incorporate the latest knowledge or newer local practices and achieve a consensus within the radiology department(s). Unfortunately, editing and maintaining up-to-date protocols in a formalized way is a time-consuming activity, which requires high cooperation between the radiologists and technologists of an institution. As a consequence, in many radiology departments, there is no document or system describing the protocols. As such, the expertise and training of the radiologists and technologists is relied upon to assure a certain level of standardization.
An example of how a particular protocol is selected for a particular patient is described next in connection with typical workflow for a patient who is to be imaged. A prescribed order from a referring physician for an imaging examination is received by a radiology department, imaging center or the like. The order typically describes the general type of examination (CT, MRI, PET, US, etc.) and the anatomy to be scanned. Additionally, the order will include the clinical indications that resulted in the order. The clinical indications usually include signs, symptoms, and clinical history, and may also include hypotheses of the underlying disease or condition or mention “rule-out,” which also suggests potential conditions that should be investigated in particular.
A radiologist reviews the order and assigns a clinical imaging protocol for the patient based on the specific clinical indications. Other information may also be reviewed to help make this decision, including laboratory data, prior radiology reports, and/or other clinical reports. The clinical imaging protocol defines the settings used on the imaging equipment to acquire the images, and directs the imaging technologist who operates the scanner in how to perform the examination. The protocol as described here will result in an imaging study that is comprised of one or more image series of different geometry or contrast, which in turn are comprised of one or more images. The selection of the protocol generally occurs before the patient is scanned, depending on departmental workflow maybe also hours to days before the patient arrives for the examination.
By way of further example, a patient's imaging order may include the indication “hearing loss in left ear,” with the note to perform an “MRI of the head.” Within this general examination type, there are many options of clinical imaging protocols that are used specifically by the imaging centre or radiology department. Examples that are under the general category “MRI of the head” may include “brain tumor,” “multiple sclerosis,” “angiography,” “MR without contrast,” “internal auditory canal,” “eye-orbit,” to name a few. A radiologist reading this order may decide that the order is best fulfilled by using the “internal auditory canal” protocol.
Conventional software applications that facilitate a radiologist with selecting a protocol generally are focused on digitizing what has previously been a paper process. Such applications electronically collect the order and other clinical information about the patient, and provide a digital list of clinical scan protocols for a radiologist to manually choose from. Unfortunately, such solutions do not provide assistance in choosing a particular one of the listed protocols. As a result, protocol selection consumes radiologist time and is susceptible to human error, and there tend to be inconsistencies between selected protocols amongst radiologists, even in the same imaging facility.